Staghorn calculi causes and

treatment
Brad Weaver
8/19/08
Struvite stones
Composed of magnesium ammonium
phosphate triple phosphate crystals
Precipitate at alkaline pH created by urease
producing bacteria such as Proteus or
Klebsiella
Urease
Urea 2NH3 + CO2
NH3 + H20 NH4+ + OH-
Magnesium ammonium phosphate crystals
orthorhombic shape
Struvite stones cont.
Occur 3:1 ratio female:male
More common in those anatomically
predisposed to infection such as with
neurogenic bladder or urinary diversion
Staghorn calculi may also contain mixed
calcium/struvite or all calcium stones
The presence of calcium warrants metabolic
workup for cause of stones


Struvite stone symptoms
Often no symptoms directly related to stone
May present with UTI, flank pain, hematuria
Passage of struvite stone is rare
Can rapidly grow and lead to chronic
pyelonephritis and parenchymal scarring
Struvite stones are radiopaque and can be
seen on AXR and CT
Abdominal plain film showing b/l
radiopaque staghorn calculi
CT w/o contrast showing R staghorn
calculus
Cystine stones
Cystine stones may also
form staghorn calculi
Cystinuria is a rare
autosomal recessive disease
responsible to 1-2% of
stone formers
Caused by mutations in
genes, SLC3A1 and SLC7A9,
that are involved in amino
acid transport
Median age of onset of
kidney stones is 12

Hexagonal crystals in urine
sediment
Treatment with fluids, alkali,
cystine binding drugs
penicillamine, tiopronin,
and captopril
Medical management of staghorn
calculi
Dietary phosphorus reduction
Antibiotics rarely successful at eradicating
bacteria in struvite stone
Acetohydoxamic acid (AHA, Lithostat) is a
urease inhibitor that has been shown to stop
stone growth in 80% vs. 40% on placebo. Use
is limited by frequent side effects including
palpitations, nausea, and hemolytic anemia
Surgical management
Open surgery
Percutaneous nephrolithotomy (PNL)
Shock wave lithotripsy (SWL)
Retrospective study
112 patients with staghorn calculus with mean
follow up 7.7 years



Renal deterioration occurred in 28%
Worse outcome associated with solitary
kidney, recurrent stones, hypertension,
urinary diversion, and neurogenic bladder
J Urol 1995 May;153(5):1403-7